Discussion: What are three to four components to recommend as part of Bill’s treatment.
Discussion: What are three to four components to recommend as part of Bill’s treatment.
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Tina, a 10-year-old child, has had difficulties since the first day of school when she cried and hid in the basement. For the past 3 months, Tina has had a variety of somatic complaints, such as headaches and “tummy aches,” and only goes to school reluctantly after much cajoling by her parents. Tina states that she is uncomfortable anytime her family members are out of sight because she is afraid something bad will happen.
Bill awoke in the middle of the night, gasping for breath, sweating, shaking, experiencing a racing heart, and thinking “I could be dying.” It was his third attack of the week, and at least the tenth that month that had awakened him from sleep. Similar episodes occur during the day and have been occurring for nearly a year. These attacks are unpredictable, so he experiences constant concern about when another one will occur. In addition to the recurrent attacks, Bill fears being in situations like inside airplanes, elevators, movie theatres or traveling in the middle lane of a road. During this past year, he has avoided these situations because he is concerned about the possibility of experiencing these anxiety attacks and not being able to comfortably escape these settings. When he must travel, he usually has a friend or relative accompany him.
Kara states that the reason she is anxious is that, for the last 6 months, she has been afraid that she will faint without warning. She is concerned that if she faints in public, no one will come to her aid or it might result in an embarrassing scene. She started avoiding enclosed places and public transportation. Now she is concerned about being away from home at all. If she has to leave home, which she’ll only do if her husband is with her, the fear of fainting dominates her thinking. She is unable to work or socialize due to these fears.
Miguel: A 30-year-old mail carrier has been “super self-conscious” when speaking to strangers, co-workers, and sometimes even to friends for the past two years. While around others he often feels nervous, has hot flashes, perspires, trembles, and feels somewhat detached from himself. He feels uncomfortable in social situations because he is afraid of doing something embarrassing or saying something stupid. He is also concerned that others will notice his anxiety. Because of this fear, he turns down invitations to parties and withdraws from other social activities.
Karina: A 28-year-old housewife has had a fear of thunderstorms for two years. She is most frightened by lightning but is uncertain about the reason for this. While she has a fear of being struck by lightning, she recognizes that it is an unlikely occurrence. She begins to feel anxiety long before a storm arrives. A weather report predicting a future storm can cause her anxiety to increase to the point that she worries for days before the storm. During a storm she often tries to make plans to visit friends or relatives because being with another person reduces her fear. If she is alone during a storm, she covers her eyes or moves to a part of the house far from windows where she cannot see lightning should it occur.
Jim, a 27-year-old, electrician has been feeling anxious for over 18 months. Most every day he experiences irritability, muscle tension, fatigue, and a constant “edgy” feeling that often interferes with his ability to concentrate. Jim admits to being a chronic worrier who frequently feels uptight about multiple things. These feelings are pervasive; they are not limited to discrete periods.
Courtney: Shortly after beginning a new antibiotic (Floxin) for a skin infection, Courtney started experiencing panic attacks. During these attacks, she experienced tremors, apprehensiveness, shortness of breath, and numbness. She wondered if she was “going crazy.” It was recommended that she discontinue the Floxin and within a few days the anxiety symptoms remitted.
*Cases adapted from the DSM-IV Case Book, First Edition, by the American Psychiatric Association (1994).
Treatment Planning: Practice
Take the cases of Bill and Miguel from the Diagnostic Cases handout.
What are three to four components to recommend as part of Bill’s treatment?
What are three to four components to recommend as part of Miguel’s treatment?
Answer preview to what are three to four components to recommend as part of Bill’s treatment
